Surgical instrument drill for biopsy

ABSTRACT

The device is a surgical instrument having a pair of pivotally mounted surgical blades for removing a conical section, which blades are coupled by linkage means so that their angular movement is controlled as the handle means acts as a sleeve to permit angular rotation of the supporting means with which the blades coact. The linkage means includes a pair of pivotally mounted support arms which in their extended position extend outwardly from the supporting means and in their retracted position partially extend within a slot in the supporting means and in overlapping relation to each other.

United States Patent [72] Inventor Mikio K810 2,249,906 7/1941 Longoria 128/305 1003 Nottingham Place, La Vale, Md. 3,147,749 9/1964 Marsh 128/305 X 21502 3,357,422 12/1967 Creelman 128/2 B [21 1 Appl 75l5l Primary Examiner-Channing L. Pace [22] Flled Sept 1970 Attorney-Leonard W. Suroff [45] Patented Dec.2l,l971

ABSTRACT: The device is a surgical instrument having a pair [54] SURGFIAL f gp DRILL FOR BIOPSY of pivotally mounted surgical blades for removing a conical loclmmsfl Drawmg section, which blades are coupled by linkage means so that [52] US. Cl 128/2 B, their angular movement is controlled as the handle means acts 128/305, 30/300 as a sleeve to permit angular rotation of the supporting means [51] [Ill-Cl ..A61b 10/00, with which the blades coact, The linkage means includes 3 A61 17/ 2, 1326b pair of pivotally mounted support arms which in their ex- [50] Field 0! Search 30/300, tended position extend outwardly from the supporting means /Z 310 and in their retracted position partially extend within a slot in the supporting means and in overlapping relation to each [56] References Cited omen UNITED STATES PATENTS 958,941 5/1910 Rose 30/300 A: 9/ 59 72 7 i 8/ 75 77 T /5 5 V l 76 I SURGICAL INSTRUMENT DRILL FOR BIOPSY BACKGROUND OF THE INVENTION The present invention relates generally to an improved sur gical instrument, and particularly to an instrument for the removal of a conical section'of the body of the cervix for a biopsy.

The present method of cervical conization for a biopsy is not satisfactory because many surgeons use the ordinary scalpel with the pointed blade which cuts the tissue in irregular shape or, on many occasions in pieces, instead of a uniform conical shape which is required for biopsy for microscopic examinations.

The few instruments which are available for this operation are unsatisfactory because they are either single bladed with no advance clamping to make the cone shape evenly and quickly and cause considerable blood loss.

BRIEF SUMMARY OF THE INVENTION The invention utilizes a pair of cutting blades mounted at one end of the drill so that not only does it advance as it cuts, but also clamps towards the cervical canal or center of the canal and makes a uniform substantially bloodless cone, ideally suitable for biopsy.

It consists of an elongated obturator insertable lengthwise into the endocervical canal. A stopper in the form of a shoulder physically connected with the obturator engages the endocervix extremity and limits the penetration of the obturator to a controlled depth.

A handle at the opposite end of the instrument controls the movement of the obturator to effect the insertion. A pair of pointed cutting blades pivotally mounted on an axis at a right angle to the obturator axis can be moved toward each other and pressed through the cervical tissue to the cervical canal and obturator out of contact with the cervix.

The blades are actuated by a member extending to a convenient point of accessibility at the handle end, and rotate in a conical path with provisions for adjusting the effective length of the blade and the radius of the path to vary the base dimension of the conical section removed.

OBJECTS OFTHE INVENTION An object of the invention is to provide a surgical instru ment with which to remove reliably and precisely a symmetrical cone of tissue which shape and size of the cone may be of controlled dimensions. I 7

Another object of the invention is to provide a surgical instrument capable of use to remove a conical specimen of selected size without disrupting or unnecessarily cutting into adjoining tissue.

Another object of the invention is to provide a surgical instrument which simultaneously advances as it cuts, and also clamps toward the cervical canal and makes a uniform bloodless cone ideally suitable for biopsy.

Other objects of the invention will become apparent as the description of the invention proceeds.

BRIEF DESCRIPTION OF THE DRAWINGS Although the characteristic features of this invention will be particularly pointed out in the claims, the invention itself, and the manner in which it may be made and used, may be better understood by referring to the following description taken in connection with the accompanying drawings forming a part hereof, wherein like reference numerals refer to like parts throughout the several views and in which:

FIG. 1, is a perspective view'illustrating the instrument in supported relation to the patient;

FIG. 2, is a top view of the instrument;

FIG. 3, is a longitudinal section view of the instrument in operating position in relation to the cervix;

FIG. 4, is a longitudinal section view similar to FIG. 3, with the cutting blades in their extended position;

FIG. 5, is an enlarged fragmentary view of the linkage means and cutting blades mounting taken on the line 5-5 in FIG. 3;

FIG. 6, is an enlarged sectional view of the handle means taken along line 6-6 of FIG. 3; and

FIG. 7, is an enlarged sectional view similar to FIG. 6, taken along line 7-7 of FIG. 3.

DETAILED DISCUSSION OF THE DRAWINGS The surgical instrument or drill 10 shown in FIGS. 1-7 includes elongated support means 12 having control means 15 at one end and at its opposite distal end 14 a longitudinally projecting positional referencing element comprising the elongated obturator 16 terminating at its base in an annular flange or shoulder 18 which functions as the stop. The smoothly surfaced longitudinally extending obturator I6 is designed for insertion by the user 13 into the endocervical canal of the human patient 19 to a depth limited by the stop shoulder 18 and to permit rotational movement of the instrument about an axis defined by the canal.

To permit the controlled cutting and equal pressure to be simultaneously applied in two areas cutting means in the form of a pair of cutting blades 20 and 21 are utilized. Each blade is respectively mounted by its tab portion 22 extending at substantially right angle to the blade. The tab portion 22 is secured by means of a screw 24 extending through the carrier arm 25 and retained in place by nut 26 as seen particularly with respect to FIG. 5. a

The movement of the respective cutting blades 20 and 21 is obtained by the linkage means 23 connecting the blades 20 and 21, support means 12 and control means 15, which will be hereinafter explained in detail. The obturator 16 having a circular configuration extends longitudinally from the stop or shoulder 18 which terminates at one end of the rod 28 having an enlarged middle section 30 with a circumferential recess 32 to provide a cross section of reduced diameter as seen in FIG. 6. The rear surface 34 of the middle section 30 has a longitudinally extending shaft 36 with the control means 15 positioned thereon and consisting of a disc 38 having a bore extending therethrough to accept the contoured shaft end which is held in place by a setscrew 40. A handle or control knob 42 is secured to the disc 38 as by a pin 44 to hold the knob in place.

To permit the support means 12 to be rotatably mounted about the obturator axis, handle means 45 is provided and designed to telescopically enclose the recess 32 in the middle section 30 of the support means 12.

The handle means 45, as seen in FIGS. 6 and 7, includes an upper frame 46 having a contoured seat 48 to be contained in the recess 32 with spaced-apart faces 50 and vertically extending tapped hole 51 extending therethrough. A lower frame 52 has a seat 54 for containment within the recess 32 and similarly spaced-apart faces 55 which engage faces 50, and maintained in place by means of fasteners 56 which extend through a vertically extending counterbored hole 58 to extend within the tapped hole 51. In this manner the handle means 45 remains in secured position with respect to the support means 12. The lower frame 52 has a downwardly extending neck portion 59 with a cavity 60 extending inwardly from its bottom end 62 and spaced-apart grooves 64 which accommodate spring clips 65. A gripping member 66 has a head portion 68 with depressions at one end thereof, which is adapted to be accepted within the cavity 60 so that the clips extend into the depressions to prevent accidental removal of the gripping member 66. In. this manner the surgeon or other person may easily disassemble or assemble the drill I0 by merely putting in or removing the gripping member 66. The dimensional relationship of the recess 32 to the upper frame 46 and lower frame 52 is such that the obturator 16 is freely rotatable in conjunction with the linkage means .23 as hereinafter explained. Obviously various mounting means for free rotation of the obturator may be selected such as a ball bearing, etc.

Accordingly, the dimensional relationship between the sleeve as comprised by the upper frame 46 and lower frame 52 permit free angular rotation of the barrel supporting means 12 as the recess 32 is positioned therein and the handle means is held by the user 13 as seen in FIG. 1 and the control means 15 is manipulated by gripping of the knob 42 and angularly rotating same.

The blades and 21 are actuated for movement both in an arcuate path and longitudinally to define a conical path with provisions for adjusting the effective length of the blade and the radius of the path to vary the base dimension of the conical section removed.

To obtain the relative motion of the blades linkage means 23 is utilized so as to obtain the controlled movement of each blade individually as seen in FIGS. 3, 4 and 7. The middle section 30 has two spaced-apart axially extending bores 70 therethrough to accept rods 72 in free sliding relationship. The rear end of each rod 72 is seated within a coupling member 75 having a counterbore 76 in one end and a screw 77 extending through it opposite end and into the rod 72 to retain the latter in fixed relation to the coupling member 75. The coupling member 75 has an internally threaded bore 78 which mates with the externally threaded portion 79 of the axially extending collar member 80 which has an axial bore 81 to permit its telescopic association with the shaft 36. The rear of the collar member 80 has threadably engaged thereon a support plate 82 which is secured in fixed relation to the support means 12 by means of support members 84, shown in the form of screws, that extend through the washer 85 and support plate 82, and into the lower frame 52. A nut 86 acts to lock the support plate 82 against the head of the screw. By means of this novel construction rotation of the support means 12 via the shaft 36 by means of control knob 42 effects angular rotation to the middle section 30. The angular rotation of the collar member 30 effects longitudinal linear motion of the coupling member 75 which in turn is transmitted to the respective rods 72 as indicated by the arrows 88 in FIGS. 3 and 4. As seen the blades are in an open position in FIG. 4 and in a closed position in FIG. 3 with the coupling member 75 moved closer to the rear end 34 of the middle section 30 as the disc 38 is rotated.

The front end of each shaft 72 has a flat depression area 89 with an associated link member 90 having a flat surface 92 in overlapping relationship to the surface 89 and secured together by a pin or screw 9l.-

The other end of the link 90 has a fiat shoulder portion 94 a seen in FIG. 3 which is pivotally connected by screw 95 to the respective carrier arms 25. The two carrier arms are pivotally connected together by means ofa cross pin or screw 96 contained in a slot 97 contained within the rod section 28 and which acts as a first pivot point with the second pivot point defined by the screw 95. The carrier arms 25 each have a rear step 98 so that they may overlap each other at their first pivot point 96 in the slot 97. in similar fashion a front step 99 is provided to accept the width of the flat surface 94 of the link member 90. In this manner as seen in FIG. 2 a minimal space is required for the width of the linkage means 23 so that it may be contained within the slot 97.

Actuation of the blades 20 and 21 in an arcuate sense is effected by rotation of the knob 42 as the handle means 45 is held in fixed position by the user 13. Such motion is produced by longitudinal reciprocation of the rods 72 in the direction of arrows 88, with the front ends of the rods 72 pivotally coupled to link member 90 by screw 91 at it rear end. The front of the link member is pivotally secured to the carrier arm 25 by means of screws 95 such that the carrier arms pivot from the first pivot point about screw 96 to define the arc of the blades as seen in from FIG. 4 to FIG. 3. The cutting action of the blades 20 and 21 will take place while the obturator 16 is positioned within the endocervical canal as depicted in FlG. 3 by holding the instrument firmly against the cervix by means of an inwardly directed force applied to the handle means 45, the surgeon may then have the blades 20 and 21 continuously advanced towards the rotating obturator 16 as the control knob 42 is rotated. By adjustment of the blades the size of the conical portion for biopsy to be removed may be selected.

Although illustrative embodiments of the invention have been described in detail herein with reference to the accompanying drawings it is to be understoodthat the invention is not limited to those precise embodiments, and that various changes and modifications may be effected therein without departing from the scope or spirit of the invention.

I claim:

1. A surgical instrument comprising:

A. support means in the form of an elongated support member including:

1. an obturator at one end thereof terminating in a shoulder to act as a stop,

2. a middle section adjacent said obturator having a portion thereof of cross-sectional area greater than said obturator with two axially extending bores therethrough, and

3. a shaft extending rearwardly from said middle section at said opposite end of said support member,

B. handle means coupled to said middle section to permit angular rotation of said support means relative to said handle means,

C. control means secured to the end of said shaft relative to said handle means,

D. cutting means in the form of a pair of blades secured to carrier arms pivotably mounted on said support adjacent said obturator for movement in an arcuate path as said support means is angularly rotated, and

E. linkage means for moving said cutting blades in said arcuate path as said support means is angularly rotated to define a conical section, said linkage means including:

1. a pair of spaced-apart rods extending within said axially extending bores in said support member in free sliding relationship thereto,

2. a coupling member secured to the rear end of said rods and having an internally threaded portion,

. a collar member having an externally threaded portion which mates with the internally threaded portion of said coupling member and an axial bore through which said shaft extends,

4. means for mounting said collar member to said support member, wherein as said control means is manipulated by the user and rotation of said support means relative to said handle means occurs said coupling member is moved axially by said collar member engaging said coupling member by their respective threaded portions to effect the desired axial movement in said rods, and

5. a link member pivotally secured to each of said rods at one end thereof and pivotally secured at its respective other end to said carrier arms between said blade and said support member wherein the axial movement of said rods by said linkage means effects the pivotal movement of said cutting blades to define a conical path of motion for said blades.

2. A surgical instrument as defined in claim 1, wherein said means for mounting said collar member to said support means includes a support plate secured to said collar member and support members extending between said support plate and said support means.

3. A surgical instrument as defined in claim 1,

a. wherein said middle section has a peripheral recess, and

b. said handle means includes:

I. an upper frame having a contoured seat contained in said recess with spaced-apart faces,

2. a lower frame having a contoured seat contained in said recess with complimentary spaced-apart faces which engage the faces of said upper frame, and

3. means for securing said upper and lower frame together, the dimensional relationship of said recess and contoured seats permits free angular rotation of said support member relative to said frames.

4. A surgical instrument as defined in claim 3, said handle means further includes:

a. a cavity in said lower frame with spaced-apart grooves contained therein, I

b. a gripping member for engagement by the user, having a head portion with depressions adapted to be accepted in said cavity, and

c. clips contained in said grooves and depressions to maintain said gripping member in removably secured relation to said lower frame.

5. A surgical instrument as defined in claim 1,

a. wherein said support member has a transverse slot extending therethrough, and

b. said carrier arms are pivotally secured to said support member within said slot, and each carrier arm has a rear step in overlapping relationship to each other.

6. A surgical instrument as defined in claim 1, wherein said blades are each secured to a tab which is adjustably secured to the forward end of said carrier arm for adjusting the angle of said blade with respect to said obturator.

7. A surgical instrument as defined in claim 1, wherein said control means includes a disc secured to said shaft with a knob extending therefrom for the manual rotation thereof.

8. A surgical instrument for conization of the uterine cervix, comprising:

A. support means in the form of a support member including:

1. an elongated obturator insertable lengthwise into the endocervical canal,

2. stops means in the form ofa shoulder on said obturator to act as a stop to limit the penetration of the obturator,

3. a middle section adjacent said shoulder having a portion thereof of cross-sectional area greater than said obturator with two axially extending bores therethrough and a peripheral recess, and

4. a shaft rigid with said middle section and extending rearwardly therefrom at said opposite end of said support member,

B. handle means coupled to said middle section to permit angular rotation of said support means relative to said handle means, said handle means including:

1. an upper frame having a contoured seat contained in said recess with complimentary spaced-apart faces,

2. a lower frame having a contoured seat contained in said recess with complimentary spaced-apart faces which engage the faces of said upper frame, and

3. means for securing said upper and lower frame together, the dimensional relationship of said recess and contoured seats providing free angular rotation of said support member relative to said frames,

C. control means secured to the end of said shaft in the form of a member having a knob secured thereto wherein rotation of said member by said knob effects rotation of said support means relative to said handle means,

D. cutting means in the form of a pair of pointed blades adapted to pierce the cervix and secured to carrier arms pivotably mounted on said support member adjacent said obturator for movement in an arcuate path for cutting through the cervix tissue as the support means is angularly rotated, said carrier arms being pivotably secured to said support within a slot therein,

E. means for adjusting the angle of said blades with respect to said obturator to define the size of a conical specimen to be removed,

F. linkage means for moving said cutting blades in said arcuate path as said support means is angularly rotated to define a conical section, said linkage means including:

1. a pair of spaced-apart rods extending within said axially extending bores in said support member in free sliding relationship thereto,

2. a coupling member secured to the rear end of said rods and having an internally threaded portion, 3. a collar member having an externally threaded portion which mates with the internally threaded portion of said coupling member and an axial bore through which said shaft extends,

4. means for mounting said collar member to said support member, wherein, as said control means is manipulated by the user and rotation of said support means relative to said handle means occurs, said coupling member is moved axially by said collar member engaging said coupling member by their respective threaded portions to effect the desired axial movement in said rods, and

5. a link member pivotally secured at one end thereof to each of said rods and pivotally secured at its respective other end to said carrier arms between said blade and said support member wherein the axial movement of said rods by said linkage means effects the pivotal movement of said cutting blades to define a conical path of motion for said blades.

9. A surgical instrument as defined in claim 8, wherein said means for mounting said collar member to said support means includes a support plate secured to said collar member and support members extending between said support plate and said support means.

10. A surgical instrument as defined in claim 8,

a. wherein said middle section has a peripheral recess, and

b. said handle means includes:

1. an upper frame having a contoured seat contained in said recess with spaced-apart faces,

2. a lower frame having a contoured seat contained in said recess with complimentary spaced-apart faces which engage the faces of said upper frame, and

3. means for securing said upper and lower frame together, the dimensional relationship of said recess and contoured seats providing free angular rotation of said support member relative to said frames. 

1. A surgical instrument comprising: A. support means in the form of an elongated support member including:
 1. an obturator at one end thereof terminating in a shoulder to act as a stop,
 2. a middle section adjacent said obturator having a portion thereof of cross-sectional area greater than said obturator with two axially extending bores therethrough, and
 3. a shaft extending rearwardly from said middle section at said opposite end of said support member, B. handle means coupled to said middle section to permit angular rotation of said support means relative to said handle means, C. control means secured to the end of said shaft relative to said handle means, D. cutting means in the form of a pair of blades secured to carrier arms pivotably mounted on said support adjacent said obturator for movement in an arcuate path as said support means is angularly rotated, and E. linkage means for moving said cutting blades in said arcuate path as said support means is angularly rotated to define a conical section, said linkage means including:
 1. a pair of spaced-apart rods extending within said axially extending bores in said support member in free sliding relationship thereto,
 2. a coupling member secured to the rear end of said rods and having an internally threaded portion,
 3. a collar member having an externally threaded portion which mates with the internally threaded portion of said coupling member and an axial bore through which said shaft extends,
 4. means for mounting said collar member to said support member, wherein as said control means is manipulated by the user and rotation of said support means relative to said handle means occurs said coupling member is moved axially by said collar member engaging said coupling member by their respective threaded portions to effect the desired axial movement in said rods, and
 5. a link member pivotally secured to each of said rods at one end thereof and pivotally secured at its respective other end to said carrier arms between said blade and said support member wherein the axial movement of said rods by said linkage means effects the pivotal movement of said cutting blades to define a conical path of motion for said blades.
 2. a middle section adjacent said obturator having a portion thereof of cross-sectional area greater than said obturator with two axially extending bores therethrough, and
 2. A surgical instrument as defined in claim 1, wherein said means for mounting said collar member to said support means includes a support plate secured to said collar Member and support members extending between said support plate and said support means.
 2. a coupling member secured to the rear end of said rods and having an internally threaded portion,
 2. a lower frame having a contoured seat contained in said recess with complimentary spaced-apart faces which engage the faces of said upper frame, and
 2. stops means in the form of a shoulder on said obturator to act as a stop to limit the penetration of the obturator,
 2. a lower frame having a contoured seat contained in said recess with complimentary spaced-apart faces which engage the faces of said upper frame, and
 2. a coupling member secured to the rear end of said rods and having an internally threaded portion,
 2. a lower frame having a contoured seat contained in said recess with complimentary spaced-apart faces which engage the faces of said upper frame, and
 3. means for securing said upper and lower frame together, the dimensional relationship of said recess and contoured seats providing free angular rotation of said support member relative to said frames.
 3. a collar member having an externally threaded portion which mates with the internally threaded portion of said coupling member and an axial bore through which said shaft extends,
 3. means for securing said upper and lower frame together, the dimensional relationship of said recess and contoured seats providing free angular rotation of said support member relative to said frames, C. control means secured to the end of said shaft in the form of a member having a knob secured thereto wherein rotation of said member by said knob effects rotation of said support means relative to said handle means, D. cutting means in the form of a pair of pointed blades adapted to pierce the cervix and secured to carrier arms pivotably mounted on said support member adjacent said obturator for movement in an arcuate path for cutting through the cervix tissue as the support means is angularly rotated, said carrier arms being pivotably secured to said support within a slot therein, E. means for adjusting the angle of said blades with respect to said obturator to define the size of a conical specimen to be removed, F. linkage means for moving said cutting blades in said arcuate path as said support means is angularly rotated to define a conical section, said linkage means including:
 3. a middle section adjacent said shoulder having a portion thereof of cross-sectional area greater than said obturator with two axially extending bores therethrough and a peripheral recess, and
 3. means for securing said upper and lower frame together, the dimensional relationship of said recess and contoured seats permits free angular rotation of said support member relative to said frames.
 3. a collar member having an externally threaded portion which mates with the internally threaded portion of said coupling member and an axial bore through which said shaft extends,
 3. A surgical instrument as defined in claim 1, a. wherein said middle section has a peripheral recess, and b. said handle means includes:
 3. a shaft extending rearwardly from said middle section at said opposite end of said support member, B. handle means coupled to said middle section to permit angular rotation of said support means relative to said handle means, C. control means secured to the end of said shaft relative to said handle means, D. cutting means in the form of a pair of blades secured to carrier arms pivotably mounted on said support adjacent said obturator for movement in an arcuate path as said support means is angularly rotated, and E. linkage means for moving said cutting blades in said arcuate path as said support means is angularly rotated to define a conical section, said linkage means including:
 4. means for mounting said collar member to said support member, wherein as said control means is manipulated by the user and rotation of said support means relative to said handle means occurs said coupling member is moved axially by said collar member engaging said coupling member by their respective threaded portions to effect the desired axial movement in said rods, and
 4. A surgical instrument as defined in claim 3, said handle means further includes: a. a cavity in said lower frame with spaced-apart grooves contained therein, b. a gripping member for engagement by the user, having a head portion with depressions adapted to be accepted in said cavity, and c. clips contained in said grooves and depressions to maintain said gripping member in removably secured relation to said lower frame.
 4. a shaft rigid with said middle section and extending rearwardly therefrom at said opposite end of said support member, B. handle means coupled to said middle section to permit angular rotation of said support means relative to said handle means, said handle means including:
 4. means for mounting said collar member to said support member, wherein, as said control means is manipulated by the user and rotation of said support means relative to said handle means occurs, said coupling member is moved axially by said collar member engaging said coupling member by their respective threaded portions to effect the desired axial movement in said rods, and
 5. a link member pivotally secured at one end thereof to each of said rods and pivotally secured at its respective other end to said carrier arms between said blade and said support member wherein the axial movement of said rods by said linkage means effects the pivotal movement of said cutting blades to define a conical path of motion for said blades.
 5. A surgical instrument as defined in claim 1, a. wherein said support member has a transverse slot extending therethrough, and b. said carrier arms are pivotally secured to said support member within said slot, and each carrier arm has a rear step in overlapping relationship to each other.
 5. a link member pivotally secured to each of said rods at one end thereof and pivotally secured at its respective other end to said carrier arms between said blade and said support member wherein the axial movement of said rods by said linkage means effects the pivotal movement of said cutting blades to define a conical path of motion for said blades.
 6. A surgical instrument as defined in claim 1, wherein said blades are each secured to a tab which is adjustably secured to the forward end of said carrier arm for adjusting the angle of said blade with respect to said obturator.
 7. A surgical instrument as defined in claim 1, wherein said control means includes a disc secured to said shaft with a knob extending therefrom for the manual rotation thereof.
 8. A surgical instrument for conization of the uterine cervix, comprising: A. support means in the form of a support member including:
 9. A surgical instrument as defined in claim 8, wherein said means for mounting said collar member to said support means includes a support plate secured to said collar member and support members extending between said support plate and said support means.
 10. A surgical instrument as defined in claim 8, a. wherein said middle section has a peripheral recess, and b. said handle means includes: 